Two Rescue Drugs I Always Carry On Call

As seniors, we oversee our junior trainees’ cases while coordinating the case flow through the operating rooms with our front desk during call shifts. While the junior residents and SRNAs check our “stat rooms” and emergent airway boxes prior to preparing for their respective cases, I’ll visit the pharmacy to grab syringes of my two favorite rescue drugs: epinephrine and succinylcholine.

Epinephrine is a natural stress catecholamine and an incredibly versatile drug in perioperative medicine. Bronchospasm? Give epinephrine. Anaphylaxis? Give epinephrine? Profound vaso-vagal reaction… or bradycardia… or hypotension… give epinephrine. It’s a great temporizing measure while diagnosing and treating the underlying problem.

Succinylcholine is a fast acting depolarizing neuromuscular blocker. Although there are known contraindications, if there’s an acute laryngospasm or an emergent airway, I already have my paralytic of choice ready to go! In fact, if I’m intubating a tenuous cardiac patient, I’ll often include a little epinephrine with succinylcholine and a hypnotic during my induction process.

For the overwhelming majority of my call shifts, I’ll return both syringes unused to the pharmacy. I just have peace of mind with these two in my pocket. 😀